Iodine and Reproduction

先兆子痫是一种妊娠障碍，包括高血压和蛋白尿，是母婴发病率和死亡率的主要原因。一些研究(但不是全部)发现，先兆子痫妇女的碘水平明显低于健康孕妇。解决这个问题很重要，因为怀孕期间缺碘在美国和包括芬兰在内的欧洲部分地区很常见。我们进行了一项嵌套式病例对照研究，以确定先兆子痫的风险是否与碘状况有关。对204例妊娠10-14周的先兆子痫患者和246例正常对照的血清碘、甲状腺球蛋白(TG)和促甲状腺激素(TSH)进行了检测。两组间碘(病例均值=26.04 ng/mL，对照均值=27.88 ng/mL，p=0.995)、甘油三酯(病例均值=31.11 ng/mL，对照均值=29.61 ng/mL，p=0.996)、促甲状腺激素(病例均值=1.30mIU/L，对照均值=1.24mIU/L，p=0.896)水平无显著差异。在调整已知的危险因素后，先兆子痫的风险与碘、甘油三酯或促甲状腺激素没有显著关系。考虑到怀孕期间碘缺乏症的高流行率，这些结果令人放心。 妊娠期间严重缺碘或过量会导致先天性甲状腺功能减退症(CH)。缺碘在美国孕妇中很常见。我们在加利福尼亚州250万名新生儿队列中进行了一项嵌套病例对照研究，以确定美国人口中碘状况是否与CH有关。从加州新生儿筛查计划中获得907例经新生儿筛查确诊的CH新生儿和909例与出生月份相匹配的正常对照的干血斑点，以测量全血碘浓度。比较病例和对照组之间的碘状况，并用Logistic回归分析CH状况和血碘浓度之间的关系。在新生儿重症监护病房(NICU)接受治疗的婴儿中，也比较了病例和对照组之间的碘状况，因为据报道，在NICU中暴露于高碘水平的婴儿中存在CH。 血碘浓度在病例组(中位数：20.0 ng/mL；IQR：12.1~29.8 ng/mL)与对照组(中位数：20.3 ng/mL；IQR：12.5~30.9 ng/mL；P=0.59)之间差异无统计学意义。无论是极高或极低的血碘浓度(第1、第5、第95和第99百分位数的分布)在病例中都不常见。然而，在接受NICU治疗的婴儿中，病例组的碘(中位数：22.7 ng/mL；IQR：16.4-32.1 ng/mL)显著高于对照组(中位数：17.3 ng/mL；IQR：8.3-26.6 ng/mL)。 在这一人群中，CH病例的碘含量没有明显的高或低，这是令人放心的，因为母亲缺碘在美国很常见。在NICU的新生儿中，CH病例的血碘浓度高于对照组，这表明NICU中过量的碘暴露可能是CH的原因。监测外科手术、影像检查和含碘消毒剂中的碘暴露可能是有益的，并考虑使用非碘替代品。

Preeclampsia, a pregnancy disorder that includes hypertension and proteinuria, is a major cause of maternal and fetal morbidity and mortality. Some studies, but not all, have found that women with preeclampsia have significantly lower iodine levels than healthy pregnant women. Resolving this issue is important because iodine deficiency in pregnancy is common in the USA and parts of Europe including Finland. We conducted a nested case-control study to determine whether the risk for preeclampsia is associated with iodine status. We measured serum iodine, thyroglobulin (Tg), and thyroid stimulating hormone (TSH) at 10-14 weeks gestational age in 204 women with preeclampsia and 246 unaffected controls selected from all births in Finland. We found no significant difference in iodine (case mean = 26.04 ng/mL, control mean = 27.88 ng/mL, p = 0.995), Tg (case mean = 31.11 ng/mL, control mean = 29.61 ng/mL, p = 0.996), and TSH (case mean = 1.30 mIU/L, control mean = 1.24 mIU/L, p = 0.896) levels between cases and controls. There was no significant relationship between preeclampsia risk and iodine, Tg, or TSH after adjustment for known risk factors. These results are reassuring given the high prevalence of iodine deficiency in pregnancy. Severe iodine deficiency or excess during pregnancy can cause congenital hypothyroidism (CH). Iodine deficiency is common in pregnant women in the United States. We conducted a nested case-control study in a cohort of 2.5 million births in California to determine whether iodine status is related to CH in a US population. Dried blood spots from 907 newborns with CH identified by newborn screening and 909 unaffected controls matched by month of birth were obtained from the California Newborn Screening Program to measure whole-blood iodine concentration. Iodine status was compared between cases and controls, and logistic regression was used to assess the association between CH status and blood iodine concentrations. Iodine status was also compared between cases and controls among infants treated in a neonatal intensive care unit (NICU) because CH has been reported in infants exposed to high levels of iodine in the NICU. Blood iodine concentrations did not differ significantly between cases (median: 20.0 ng/mL; IQR: 12.1-29.8 ng/mL) and controls (median: 20.3 ng/mL; IQR: 12.5-30.9 ng/mL; P = 0.59). Neither extremely high nor extremely low blood iodine concentrations (1st, 5th, 95th, and 99th percentiles of the distribution) were more common in cases. Among infants treated in NICUs, however, cases had significantly (P = 0.01) higher iodine (median: 22.7 ng/mL; IQR: 16.4-32.1 ng/mL) compared with controls (median: 17.3 ng/mL; IQR: 8.3-26.6 ng/mL). CH cases did not have significantly higher or lower iodine in this population, which is reassuring given that maternal iodine deficiency is common in the United States. Among newborns in the NICU, CH cases had higher blood iodine concentrations compared with controls, suggesting that excess iodine exposure in the NICU could be causing CH. It may be beneficial to monitor iodine exposure from surgical procedures, imaging, and iodine-containing disinfectants and to consider non-iodine alternatives.